NEUROMONITORING SIGNAL LOSS DURING VERTEBRAL COLUMN RESECTION IN SEVERE POST-TUMOUR KYPHOSCOLIOSIS WITH PROGRESSIVE MYELOPATHY: INTRAOPERATIVE MANAGEMENT AND POSTOPERATIVE NEUROLOGICAL RECOVERY

A 33-year-old man with severe post-tumor kyphoscoliosis following treatment for infantile ganglioneuroblastoma presented with progressive spastic paraparesis, neurogenic bladder, respiratory compromise and extreme spinal deformity. Imaging demonstrated 125° thoracic scoliosis, 80° lumbar scoliosis, 150° thoracic kyphosis and spinal cord myelomalacia. A two-stage posterior-only correction was planned. The first stage included removal of previous instrumentation, posterior release from T2 to L3, pedicle screw placement and internal distraction. The second stage comprised posterior column osteotomies from T8 to L2, vertebral column resection at T6–T7 and anterior fusion from T5 to T8, with continuous intraoperative neuromonitoring. A significant neuromonitoring signal drop occurred during expandable cage placement at T6–T7 and partially recovered following systemic and local corrective measures. Postoperatively, the patient developed motor paraparesis with preserved sensation. Neurological function gradually improved with intensive rehabilitation, and at two months he regained the ability to stand and walk with assistance. Thoracic kyphosis improved from 150° to 100° and scoliosis from 80° to 25°, with a 13 cm increase in overall height. T1–T12 height increased from 10.8 to 20 cm and T1–S1 height from 27 to 38 cm. Imaging confirmed fusion without hardware-related complications, while respiratory and cardiovascular function improved markedly. This case demonstrates that even extreme spinal deformity with pre-existing neurological compromise may be addressed using staged posterior-only vertebral column resection. Careful surgical planning, continuous neuromonitoring, immediate response to signal deterioration and intensive postoperative rehabilitation are essential when pursuing major correction in this high-risk setting.